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The gastrointestinal system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Sharon J. White, Francis A. Carey
Non-congenital intestinal diverticula are abnormal out-pouchings of mucosa without associated smooth muscle, often extending through the bowel wall to reach mesenteric or subserosal fat (Figure 10.42). The presence of such diverticula (diverticular disease) is common in the colon, particularly in the sigmoid colon. Diverticula occur near the taenia coli at the points of penetration of blood vessels. There is marked adjacent muscular hypertrophy, and the mucosa can be thrown up into a complex pattern of folds. Diverticular disease is a condition of older individuals, and is associated with increased intraluminal pressure, probably as a result of a low-fibre diet. Patients complain of colicky lower abdominal pain. Complicated disease occurs when diverticula become ulcerated, often due to an impacted faecolith. Bacterial infection can ensue, leading to a localized abscess or, worse, disseminated peritonitis with septicaemia. Localized disease not uncommonly leads to fistula formation, particularly to the bladder and vagina. Diverticular disease does not predispose to malignancy.
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
It is important to distinguish between diverticulosis, diverticular disease and diverticulitis. Diverticulosis is asymptomatic. Diverticular disease causes such symptoms as lower abdominal pain, bloating, constipation and rectal bleeding. Diverticulitis is accompanied by signs of inflammation, such as fever, tachycardia and peritonism, in addition to raised inflammatory markers. When diverticulitis is diagnosed, CXRs and AXRs may be performed to rule out such complications as perforation and obstruction. USS may demonstrate collections and free fluid, but CT scan is a more accurate test. The majority of diverticulitis cases will respond to conservative management, but occasionally surgical resection of the affected segment of bowel is required. Following the acute phase, barium enemas or endoscopy (sigmoidoscopy/colonoscopy) can be performed for further assessment.
Complicated Diverticulitis Excluding Perforation
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Colonic diverticula represent saccular outpouchings of the colonic wall (see Figure 49.1). Most patients with diverticulosis are asymptomatic. Symptomatic diverticular disease represents a whole range of conditions ranging from mild abdominal pain and bloating (see Chapter 49) to free perforation with peritonitis and sepsis (see Chapter 50). These presentations are stratified into complicated or uncomplicated diverticulitis. Patients with left-sided abdominal pain and sometimes fever and leukocytosis are considered to have uncomplicated diverticulitis. Complicated presentations are defined as episodes of free perforation, obstruction, stricture or fistula. Diverticular haemorrhage is associated with diverticulosis and not diverticulitis (see Chapter 75). Because of the wide range of clinical presentations and potential for significant morbidity/mortality, management of diverticular disease continues to represent a major challenge to clinicians. This chapter focuses on the current evaluation and treatment of complicated left-sided colonic diverticulosis and diverticulitis.
Colorectal resection in end-stage renal disease (ESRD) patients: experience from a single tertiary center
Published in Acta Chirurgica Belgica, 2022
Julie Frezin, Julie Navez, Paryse Johnson, Philippe Bouchard, Sébastien Drolet
Concerning diverticular disease, our study included a few patients operated for diverticulitis (n = 12). There was no difference in morbidity and mortality between elective and emergency surgery. However, the rate of ostomy was higher in the emergency surgery group. Moran-Atkin et al. [18] compared 834 ESRD patient operated in emergency for diverticulitis with 161 ESRD patients who beneficiated from elective surgery. The two groups were matched for age categories, race, sex and period of admission. In-hospital mortality was not significantly different but overall morbidity, ostomy placement and LOS was higher in the emergency group. Compared to the general population, ESRD operated electively still had a 17.3 increased odd of mortality. Thus, indication for elective surgery after diverticulitis in ESRD patients should be individualized as it is still associated with high morbidity and mortality.
The outcomes of Clostridioides difficile infection in patients with diverticular disease: a nationwide analysis
Published in Scandinavian Journal of Gastroenterology, 2019
Abubaker O. Abdalla, Sai B. Narala, Mohamed A. Abdallah, Rajkumar Doshi, Nageshwara Gullapalli
Although our study is the largest study to-date analyzing the outcomes of CDI in patients with and without diverticular disease from a large population database, it has all the limitations of retrospective study design. Our study is limited using NIS sample that utilizes in-patient billing codes and discharge diagnoses. There were significant differences in baseline characteristics and comorbidities between patients with and without diverticular disease. We attempted to adjust for all observed differences using multivariate logistic regression analysis. We tried to capture as many risk factors and comorbidities as possible but there might still be other factors that we did not account for that can potentially confound the final results. Giving the nature of NIS database, we were unable to gauge the severity of CDI, need for surgical procedures, invasive interventions, or admission to intensive care unit (ICU). We could not assess for the severity of diverticular disease, type of antibiotic used, or complications related to diverticulitis.
Incidence of diverticular bleeding: a population-based study
Published in Scandinavian Journal of Gastroenterology, 2019
G. D. Olafsson, J. P. Hreinsson, E. S. Björnsson
Diverticulosis is largely age-dependent and its prevalence is increasing in the elderly [10–12]. Prior studies have demonstrated that the incidence of diverticular disease has also increased over the past century [21,22]. Although the reasons for sudden diverticular hemorrhage are not known, there are known factors that increase the risk. These include, but are not limited to, medications such as NSAIDs, aspirin or anti-platelet drugs and anti-coagulants, as well as other clinical factors like low-fibre diets [23]. Strate et al. found both NSAIDs and aspirin to be associated with diverticular bleeding, odds ratios 1.74 and 1.25–4.02, respectively [23]. Hreinsson et al. reported an odds ratio of 3.5 for NSAIDs and low-dose aspirin of 1.52 when comparing diverticular bleeders and controls [3]. Thus, risk factors such as drugs explain very little of the causes of diverticular bleeding.